tbuckley/cabot-search huggingface dataset:
Abstract 10952: Valve-Sparing Root Replacement in Patients With Bicuspid Aortic Valves versus Patients With Tricuspid Aortic Valves: A Meta-Analysis
Authors: Sean Hamlin, Yujiro Yokoyama
Journal: Circulation (2022)

Objective: Valve-sparing root replacement (VSRR) has been described as a treatment for aortic root dilation and aortic regurgitation (AR) in both patients with tricuspid aortic valves (TAVs) and bicuspid aortic valves (BAVs); however, varied results have been reported regarding the long term need for re-intervention and subsequent aortic regurgitation in patients with BAVs. Thus, we conducted a meta-analysis to compare the outcomes of VSRR in patients with BAVs versus patients with TAVs. Methods: PubMed was searched through April 2022 to identify all studies reporting comparative outcomes of VSRR in patients with BAVs versus patients with TAVs. Short term outcomes of interest were in-hospital mortality, reoperation for bleeding, and stroke and long term outcomes of interest were long-term mortality, freedom from reoperation, and freedom from AR ≥ 2. Results: Our analysis included 13 studies reporting outcomes of 2909 patients undergoing VSRR (n = 861 for BAV group and n = 2048 for TAV group), including 9 retrospective and 4 prospective single-institution cohort studies. No significant differences were observed in terms of in-hospital mortality (hazard ratio [HR] [95% confidence interval [CI]] = 0.49 [0.18-1.35]; P = 0.17; I 2 = 0%), reoperation for bleeding (HR [95% CI] = 1.06 [0.66-1.73]; P = 0.80; I 2 = 0%), stroke (HR [95% CI] = 2.40 [0.77-7.44]; P = 0.13; I 2 = 0%), and freedom from AR ≥ 2 (HR [95% CI] = 1.60 [0.69-3.72]; P = 0.28; I 2 = 49%), though there was a trend toward greater rates of stroke and freedom from AR ≥ 2 in the TAV group. However, there were significantly lower rates of long-term mortality (HR [95% CI] = 0.47 [0.30-0.74]; P = 0.001; I 2 = 0%) and higher rates of reoperation (HR [95% CI] = 2.11 [1.26,3.54]; P = 0.004; I 2 = 19%) in the BAV group. Conclusion: VSRR can be performed in patients with BAVs with similar short term outcomes and lower rates of long-term mortality compared to patients with TAV; however, greater rates of reoperation may be observed in BAV patients.
Abstract 10881: Assess Response of Phosphodiesterase-5 Inhibitor in Pulmonary Artery Hypertension by Flow Mediated Dilation of Brachial Artery
Authors: Ujjawal Kumar
Journal: Circulation (2022)

Introduction: Endothelial dysfunction is a significant component in the development of pulmonary artery hypertension (PAH). Current treatment guidelines recommend phosphodiesterase-5 inhibitors (PDE-5i) in PAH. The responder status to PDE-5i is not assessed unlike invasive vasoreactivity testing done for calcium channel blockers. This study aims to determine the effectiveness of PDE-5 inhibitors by non-invasively testing flow mediated dilation (FMD) of brachial artery. Hypothesis: We hypothesise that FMD of brachial artery predicts the responsiveness of the PDE-5i earlier than fall in pulmonary artery pressures on echocardiography. Methods: It is a single centre prospective study over a period of 18 months where we randomly assigned PAH patients with PDE-5i. FMD in brachial artery, pulmonary arterial pressure by right ventricular systolic pressure (RVSP) by TR jet velocity and tricuspid annular planar systolic excursion (TAPSE) is measured before and after starting PDE-5i at 1 st week and at 6 th month. Primary end point is to predict the response of PDE-5i by FMD of brachial artery earlier than fall in pulmonary artery pressures through echocardiography. Secondary end point is to determine the 6 th month outcome of patients with PAH by FMD and echocardiography by RVSP and TAPSE. Results: In this study we enrolled 21 randomized cases with mean age of 40.00 ± 10.79 years, majority being females (n=17; 81%). Over a period of 18 months, primary end point is reached in 29% patients (p=0.05). Secondary end points of RVSP is achieved by 57% patients (p= 0.0014), TAPSE by 76% patients (p&lt;0.002). FMD was seen in 14 cases after 1 week and 16 cases after 6 months. Of these 14 cases all of them had a fall in RVSP and improvement in TAPSE after 6 months. Mean RVSP after 1 week is 49.24±9.56 mmHg and after 6 months is 46.00 ± 9.18 mmHg (p&lt;0.006). Mean TAPSE at 1 week is 17.10 ± 2.86 mm and at 6 months is 17.90±2.49 mm (p&lt;0.002). Conclusions: In conclusion patients having PAH initiated on PDE-5i, FMD of brachial artery predicts the responsiveness of this drug earlier than fall in pulmonary artery pressures on echocardiography by as early as 1 st week. It is a non-invasive method that helps in assessing the response of this commonly used drug in PAH in clinics.
Abstract 10410: Association Between Coronary Artery Calcium Scoring With Statin Initiation, Cholesterol Reduction and Cardiovascular Outcomes in Black Patients
Authors: Abigail Wilgor, Tony Dong, Nour Tashtish, Eddie Hackler, Ian Neeland, sanjay Rajagopalan, Sadeer Al-Kindi
Journal: Circulation (2022)

Introduction: Coronary artery calcium (CAC) scoring is a cost-effective and reproducible method to assess risk for cardiovascular (CV) outcomes and is particularly important for guiding prevention in asymptomatic patients. Black patients are at high risk for atherosclerotic cardiovascular disease (ASCVD) that is not fully explained by traditional risk factors. In this study, we investigated the prevalence of CAC and its association with CV events in Black and white individuals. Methods: We investigated the baseline characteristics, rates of statin initiation, changes in cholesterol, and major adverse CV events (myocardial infarction, stroke, death) in 49,799 patients with self-reported race (Black or white) who underwent CAC scoring in the CLARIFY study between 2014 and 2020 (Clinicaltrials.gov NCT04075162). Results: In total, there were 4,292 Black patients and 45,507 white patients. Compared with white patients, Black patients had similar age (P=0.17), were more likely to be female (60.5% vs 50%, P&lt;0.001), had higher 10-year ASCVD risk by pooled cohort equation (16.18% vs. 11.06%, P&lt;0.001), lower LDL cholesterol (115 vs 123 mg/dL, P&lt;0.001), and were more likely to have CAC of 0 (49.2% vs 39.9%, P&lt;0.001). At every 10-year ASCVD risk category by pooled cohort equation, CAC was more prevalent in white patients than Black patients (p&lt;0.001). Despite similar statin initiation post CAC score in patients not on statins at baseline, Black patients had less relative reduction in LDL cholesterol over 1 year compared with white patients (figure). Within each CAC category, Black patients had higher rates of CV events (P&lt;0.003) over 1 year. Conclusions: In this large cohort of patients undergoing CAC scoring, Black individuals had lower CAC scores despite having higher predicted ASCVD risk and worse outcomes. Black individuals had less relative reduction in cholesterol over 1 year compared with white individuals, despite having similar statin initiation rates.
Abstract 10880: Left Atrial Epicardial Adipose Tissue Predicts Atrial Fibrillation Recurrence Following Catheter Ablation
Authors: Yaacoub Chahine, Fima Macheret, Karen G Ordovas, Patrick M Boyle, Nazem W Akoum
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) recurrence following catheter ablation (CA) remains high. Epicardial adipose tissue (EAT) is increasingly recognized for its significant role in promoting AF arrhythmogenesis due to its proinflammatory properties and anatomic proximity to the myocardium. We sought to assess whether left atrial (LA) EAT volume is associated with AF recurrence following CA. Methods: EAT was assessed via cardiac MRI using a 3D Dixon sequence (Panel A) in 101 patients undergoing radiofrequency or cryoballoon CA for AF. Patients were followed for AF recurrence. Results: During an average follow-up period of 300 days, post ablation AF recurrence occurred in 31 (30.7%) patients. The median time for AF recurrence following CA was 136 days. LA EAT index was higher in those with recurrence (20.7 [16.9, 30.4] vs 13.7 [10.5, 20.1] mL/m 2 , p &lt; 0.001), and so was LA volume index (66.6 [53.8, 77.5] vs 49.9 [37.7, 62.8] mL/m 2 , p &lt; 0.001). The ROC curve for LA EAT index in the prediction of AF recurrence had an AUC of 0.77 (95% CI 0.68-0.86, p&lt;0.001) and showed an optimal cutoff value of 14.29 mL/m 2 to identify patients at risk of AF recurrence post ablation (Youden’s J statistic = 0.446). Integrating LA EAT with clinical risk factors (age, BMI, AF type and hypertension) provided a better discriminatory performance in predicting AF recurrence than clinical risk factors alone (AUC 0.79 vs 0.65, DeLong test p = 0.044) (Panel B). Cox regression analysis showed LA EAT (HR: 1.088; 95% CI: [1.047-1.13], p &lt;0.001) to be an independent predictor of post ablation AF recurrence. The Kaplan-Meier curve for recurrence free survival showed a significant difference between 2 groups of patients identified by the optimal LA EAT index cut-off of 14.29 mL/m 2 (log rank = 14.79; p &lt; 0.001) (Panel C). Conclusion: EAT quantified using cardiac MRI, a reproducible and widely accessible imaging parameter, is a strong and independent predictor of AF recurrence following CA.
Abstract 10988: The Dynamic Duo of Electrical and Thyroid Storm Caused by Amiodarone
Authors: Marc Sukhoo-Pertab, Yuriy Kuzyk, Rochelle Anne Chua, Ashok Khanna, Ashok Khanna
Journal: Circulation (2022)

Case description: A 61 year-old male with a hx of CAD s/p CABG and HFrEF s/p AICD presents with a 4-day history of dizziness and shortness of breath; he was found to be in ventricular tachycardia (VT) storm. ICD interrogation was found to have 13 shocks in 24 hours. His thyroid function tests (TFT) were abnormal: TSH undetectable, elevated FT4 7.7 (0.93-1.7) and T3 246.6 (84-202) ng/dL, respectively. He was diagnosed with severe thyrotoxicosis, likely due to amiodarone-induced thyrotoxicosis (AIT) type 2 and a Burch-Wartofsky score of 50, highly suggestive of thyroid storm (TS). He was started on hydrocortisone, prednisone, propylthiouracil, and metoprolol for the TS. Procainamide drip had been initiated for VT and titrated until VT was controlled. Repeat TFTs in 48 hours showed no changes in TSH or FT4, but T3 had normalized. Procainamide and hydrocortisone were discontinued after VT frequency had decreased. Discussion: An electrical storm (ES) is a state of electrical instability characterized by multiple episodes of VT in 24 hours. In patients with ICD, it is defined as &gt;3 anti-tachycardic pacing therapies or shock. Most patient with ES have severe underlying structural heart disease with various inciting events such as thyrotoxicosis. Amiodarone is the drug of choice in VT; however, complications such as AIT should be recognized. Thyroid hormone has a direct arrhythmogenic effect on the heart through various cellular mechanisms. In our patient, amiodarone was discontinued after the diagnosis of AIT. Procainamide and antithyroid therapy were started, which subsequently controlled the VT. Resistance to therapy can occur, and more elaborate interventions such as plasmapheresis are an option to remove amiodarone, its metabolites, and free thyroid hormones. Conclusion: Amiodarone is the most efficacious medication for VT. However, it is important to recognize possible life-threatening complications of this medication, such as AIT, which itself can exacerbate VT.
Abstract 10210: Citalopram, but Not Fluoxetine May Improve Post-Stroke Recovery
Authors: Ahmad A Toubasi, Heba M Kalbouneh, Farah H Albustanji, Yazan Y Obaid, Layla M Al-Harasis
Journal: Circulation (2022)

Introduction: Several studies evaluated the role of Selective Serotonin Reuptake Inhibitors (SSRIs) in several aspects of stroke recovery. However, the results of these studies were inconsistent. Hypothesis This study was conducted to assess the hypothesis that SSRIs improve post-stroke recovery. Methods: In this systematic review and meta-analysis, we searched the following databases: PubMed, Cochrane, Scopus and Google Scholar. The studies were included if they were placebo-controlled trials in design and reported SSRIs effects on post-stroke depression, anxiety, disability, dependence, motor abilities and cognitive functions. Results: The search yielded 44 articles that included 16,164 patients and about half of the participants were treated with SSRIs. Our results showed that SSRIs had significant effect on preventing depression (Figure 1: Weighted Mean Difference (WMD)=-7.05; 95%CI: -11.78- -2.31), treating depression (Figure 1; WMD=-1.45; 95%CI: -2.77- -0.14), anxiety (Figure 1: Relative Risk (RR)=0.23; 95%CI: 0.09-0.61), dependence (Figure 1: WMD=8.86; 95%CI:1.23-16.48), motor abilities (Figure 1: WMD=-0.79; 95%CI: -1.42- -0.15) and cognitive functions (Figure 1: WMD=1.00; 95%CI: 0.12-1.89). On the other hand, no significant effect of SSRI on disability was observed. Additionally, we found that treating with SSRIs increased the risk of seizures (RR=1.44; 95%CI:1.13-1.83). Conclusion: Our study showed that SSRIs are effective in preventing and treating depression, improving anxiety, motor function, cognitive function and dependence in post-stroke patients. These benefits were only reproducible with the citalopram sub-analysis but not fluoxetine; further well-conducted placebo-controlled trials are needed to investigate the safety and efficacy of citalopram among post-stroke patients.
Abstract 10177: Pacing-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis of Definition, Incidence, Risk Factors and Management
Authors: Vincenzo Somma, Francis J Ha, Sonny Palmer, Uwais Mohamed, Sharad Agarwal
Journal: Circulation (2022)

Introduction: Pacing-induced cardiomyopathy (PiCM) is a potential adverse sequela of right ventricular pacing. Definition varies between studies and the optimal management approach is uncertain. We aimed to characterize definition, incidence, risk factors and treatment strategies of PiCM. Methods: We performed a systematic review and meta-analysis of human studies that evaluated PiCM following pacemaker implantation identified through a literature search of PubMed and EMBASE up to March 2022. Included studies had fifty or more participants. We collected data regarding study definition of PiCM and calculated pooled prevalence across studies. Meta-analysis with random-effects modelling was used to assess association between risk factors and PiCM, reported as odds ratio (OR) with 95% confidence interval (CI). Results: Twenty-six studies (six prospective studies) with a total of 57993 patients (mean/median age 51-78 years, female 45%) were included in final analysis. Fifteen unique definitions of PiCM were reported; the most common definition was left ventricular ejection fraction (LVEF) &lt;50% and LVEF decline ≥10% after pacemaker insertion. Pooled prevalence of PiCM was 12% (95%CI, 11-14%; Figure 1). On meta-analyses, risk factors included male sex (OR 1.23 95%CI 1.12-1.35), baseline LVEF (OR 0.95 per 1% increase, 95%CI 0.93-0.97), paced QRS complex duration (OR 1.02 per msec, 95%CI 1.01-1.03) and right ventricular pacing (RVP) burden (OR 1.02 per 1% increase, 95%CI 1.01-1.02). Treatment strategies identified included cardiac resynchronisation therapy (five studies) and his bundle pacing (three studies). Conclusions: Definition of PiCM varied significantly between studies. More than one in ten patients with a pacemaker with RV pacing developed PiCM. Risk factors included male sex, baseline LVEF, paced QRS duration and RVP. The optimal management strategy is not yet established. Further research is needed to define and treat this understated complication.
Abstract 10463: Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program
Authors: Rachel J Shustak, JING HUANG, Vicky Tam, alyson stagg, Therese M Giglia, Chitra Ravishankar, Laura Mercer-Rosa, James P Guevara, Monique M Gardner
Journal: Circulation (2022)

Introduction: Interstage (IS) growth failure is a risk factor for poor outcomes in infants with hypoplastic left heart syndrome (HLHS). We hypothesize that children with greater social vulnerability are at greater risk for IS growth failure. However, IS home monitoring may mitigate disparities in IS weight gain. We sought to examine the impact of an Infant Single Ventricle Management and Monitoring Program (ISVMP) on the association of neighborhood social vulnerability and IS weight gain. Methods: We performed a retrospective single-center cohort study of infants with HLHS before (2007-2010) and after (2011-2020) the introduction of the ISVMP. IS weight gain was measured in grams per day (gm/day) and growth failure was defined as an average IS weight gain of &lt;20 gm/day. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI) with higher SVI values representing greater vulnerability. Linear and logistic regression models were used to examine the association between SVI and IS weight gain and growth failure. Models were adjusted for demographic, operative, and discharge characteristics. To test for effect modification by ISVMP, we introduced an interaction term into the models and calculated pre- and post- stratum-specific effect estimates. Results: In total, 328 infants with HLHS, were evaluated 111 before and 217 after the introduction of the ISVMP. In the total cohort, SVI was significantly associated with IS growth failure (P= 0.001). Enrollment in ISVMP strongly attenuated the association of SVI and IS growth failure (P = 0.04). Prior to ISVMP, infants in the highest and middle SVI tertiles gained 4 gm/day less than infants in the lowest SVI tertile and were more likely to experience IS growth failure (high vs. low: aOR 12.5; 95% CI 2.5-62.2; middle vs. low: aOR 7.8; 95% CI 2.0-31.2). However, after the introduction of the ISVMP, there was no difference in IS weight gain or growth failure by SVI tertile. Middle and high SVI infants enrolled in ISVMP gained 4 gm/day and 2 gm/day more than their pre-ISVMP counterparts, respectively. Conclusion: High social vulnerability is a risk factor for poor IS weight gain in infants with HLHS. However, enrollment in ISVMP significantly reduces growth disparities.
Abstract 10923: CD51 Positive-bMSCs Exosomes Coated With Macrophage Membrane Migrated to Infarct Myocardium and Reconstructed Coronary Micro-Circulation via Sox17-Vegfr Signaling Pathway
Authors: Dongmei Xie, yuanlong li
Journal: Circulation (2022)

Bone marrow-derived CD51-positive cells (CD51+bMSCs) were candidate progenitor cells for transplantation into acute myocardial infarction (AMI) mice, which could reduce death of cardiomyocytes and promote recovery of cardiac function. However, practical applications were limited by short survival time of resident cells in the injured myocardium and ball-like proliferation potential. Considering exosomes can mimic the biological effects of mother cells, we have discovered that the transplantation of exosomes secreted by CD51+bMSCs (abbreviation: CD51+bMSCs-Exo) to mice with AMI avoided the above problems, and effectively improved heart function via intramyocardial injection but not intravenous injection. The unequal effects were contributed to the different number of exosomes that attached to the injured tissues. Based on the chemotactic characteristics of macrophages to inflammatory tissues, we supposed that the chemotactic capacity of CD51+bMSCs-Exo could be improved when they encapsulated with macrophage membrane expressing multiple receptors (abbreviation: ME complex). The experimental results show that: 1) ME complex migrated to the injured myocardium after intravenous delivery and promoted the recovery of infarcted myocardium.2) Plenty of new blood vessels were emerged in the injured myocardium, which reconstructed coronary microcirculation. 3)Single-cell sequencing data found that sox17 may be an important factor to reconstruct coronary microcirculation in myocardial infarction tissue. We assessed the hypothesis that sox17 can form a positive feedback loop with VEGFR on endothelial cells. +bMSCs-Exo promotes angiogenesis. In conclusion, ME complex activates SOX17/VEGFR of endothelial cells to promote angiogenesis in AMI mice.
Abstract 10980: Echocardiographic Evaluation of the Left Ventricular Function in Patients With Noncompaction Cardiomyopathy: Biplane Method, Wall Motion Score or Global Longitudinal Strain?
Authors: Sharida Mohamedhoesein, Martijn Tukker, Emrah Kaya, Kadir Caliskan
Journal: Circulation (2022)

Introduction: Noncompaction cardiomyopathy (NCCM) is characterized by left ventricular (LV) hypertrabeculation. Therefore, endocardial tracing / quantification of LV function could be cumbersome. Hypothesis: Accurate assessment of the (subclinical) LV dysfunction in NCCM patients could improve non-invasive monitoring of disease progression, risk stratification, and treatment. Method: We reviewed the echocardiographic images of 67 patients (54% male, median age 48 year [22-73]. LV function was assessed by conventional biplane disk summation, wall motion score (WMS), and global longitudinal strain (GLS). LV function was considered abnormal if LV ejection fraction (LVEF) &lt;50% and GLS &gt;-18,9%. Results: LV function measured by biplane vs WMS showed significantly lower LV EF with WMS (p-value: 0,0016; Figure ), while the average GLS in all patients was -11,0%, SD ±3,8 (normal values: -18,9%; p-value: p&lt;0,001). By dichotomizing the group into LVEF &lt;50% vs. ≥50%, biplane EF was abnormal in 68,7%, while this was with WMS 88,1% en GLS in 100% patients. In patient with EF &lt;50% compared to ≥ 50% GLS in low biplane EF group was: -9.3% vs -14.5% (p&lt;0.001). In the WMS EF was this respectively -10,3±3,6% versus -15.5± 1.5 (p&lt;0.001). Conclusion: The systolic LV dysfunction in patients with NCCM noncompaction cardiomyopathy found by WMS and GLS was significantly lower compared to routine biplane EF measurement suggesting that WMS and GLS measurement are much more potential prognostic tool. Given the correct execution of WMS is limited by the assessor's experience, estimation of the LV function with GLS are probably most reliable. Future research should expel whether these results are representative in a larger group of patients and correlates with the clinically relevant endpoints.